Karen A. Kopciuk

The Goldberg method is a statistical approach used to identify implausible energy intakes (EI) in nutritional epidemiology. However, estimating physical activity levels (PAL) required for the method, is challenging. We quantified the accuracy of the Goldberg method combined with PAL derived from the Sedentary Time and Activity Reporting Questionnaire (Goldberg-PALSTAR-Q). Total energy expenditure derived from doubly labeled water (TEEDLW) was the comparator. Between 2009 and 2011, men (n = 40) and women (n = 59) completed a 2-week DLW protocol, a food frequency questionnaire, and the STAR-Q. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the Goldberg-PALSTAR-Q were determined. Fifty-eight percent of men and women were classified as EI underreporters by the Goldberg-PALSTAR-Q compared with 60% of men and 56% of women by TEEDLW. Among men, sensitivity, specificity, PPV, NPV, accuracy, and 95% CI were 88% (68%-97%), 87% (61%-98%), 91% (72%-99%), 81% (56%-94%), and 87% (72%-95%), respectively; and among women 79% (62%-90%), 69% (50%-84%), 77% (60%-88%), 72% (52%-86%), and 75% (62%-84%), respectively. In studies where objective EI measures are lacking, the Goldberg method and individual-level questionnaire-derived PALs can provide a viable option in sensitivity analyses exploring the influence of implausible EIs on diet and health-related associations.

Cancer screening is a high priority within the Métis community in Alberta. Despite comparable cancer incidence rates to non-Métis Albertans, Métis people face barriers to accessing cancer screening programs. This study used community-based research approaches informed by Métis ways of knowing to engage 31 individuals across Alberta about their experiences with accessing cancer screening services. Data collection was completed through two in-person Métis gatherings and six telephone interviews. Gatherings included talking circles and cultural activities, with discussions lasting approximately three hours. Topics discussed included experiences with accessing screening services, the quality of care received during appointments, and the supports needed to improve access to screening programs. Discussions were audio-recorded, transcribed, de-identified, and thematically analyzed using NVivo Software. Four prominent themes emerged from this study: (1) the impact of patient-provider communications on cancer experiences, (2) a broken healthcare system and access to care, (3) a need for support and safety, and (4) health promotion behaviours. An overarching theme of discrimination as a social determinant of health emerged throughout the findings. Tangible barriers, including geographical, transportation, and financial, were also identified by study participants. This study provides an increased understanding of Métis experiences related to cancer screening and offers direction for improvements.

Introduction: Colorectal cancer (CRC) screening is an important strategy to reduce morbidity and mortality of cancer. However, evidence on CRC screening and outcomes among Métis people is limited and results are often conflicting. Methods: This retrospective study examined CRC screening participation and retention rates, abnormal fecal test results, follow-up colonoscopy rates and wait times, and invasive CRC detection rates and distribution according to Métis status (Métis, non-Métis) and sex (male, female) from 2014 to 2022 among adults living in Alberta. Multiple administrative health databases were linked to investigate study outcomes. Adults aged 50 to 74 years who were eligible for CRC screening were included. Chi-square tests of independence and z- tests compared screening indicators between Métis and non-Métis people and between males and females within each subpopulation. Data over time and across age groups were plotted in scatter plots, and trends were assessed using Joinpoint models. Results: CRC screening participation rates among Métis males and females remained slightly higher than, or similar to, their non-Métis counterparts. However, retention rates among Métis people were lower compared to non - Métis people. Comparing females and males, participation rates were higher among females while retention rates were higher among males. A higher proportion of Métis people had abnormal FIT results than their non-Métis counterparts. There were no significant differences in invasive CRC detection rates or CRC stage distribution at diagnosis between Métis and non - Métis people. Conclusion: Findings from this study highlight the need for ongoing collaboration among Indigenous leaders, researchers, and healthcare services to support ongoing participation in CRC screening among Métis people.

Breast and cervical cancer rates among Métis people in Canada are higher than non-Indigenous people but the impact of cancer screening is uncertain. This study investigated breast and cervical cancer screening participation, retention, and follow-up care among age-eligible Métis people living in Alberta compared to their non-Métis counterparts from 2006 to 2022. Data from the Otipemisiwak Métis Government of the Métis Nation within Alberta (MNA) Identification Registry were linked to the Alberta Breast and Cervical Cancer Screening Programs, and the Alberta Cancer Registry for the years 2006 to 2022. Relative and absolute differences in rates, percentages, and means/medians were calculated between Métis and non-Métis people, including age-eligible females, people with a cervix, and people who have taken gender-affirming hormones for five or more years. Trends were assessed using suitable Joinpoint models. Métis and non-Métis people had similar breast and cervical cancer screening participation and retention rates. However, the time between abnormal cancer screening results and follow-up tests was longer for Métis people compared to non-Métis people. Métis people had higher proportions of abnormal cytology test results, and more were diagnosed with advanced-stage cervical cancer (p = 0.06) than non-Métis people. There were no differences in breast cancer stage at diagnosis. Ongoing collaboration between the MNA and Screening Programs will build on evidence from the current study to support cancer screening programs and services for all Métis people in Alberta.

The Goldberg method has been suggested for identifying energy intake (EI) under-reporting in nutritional epidemiology. Its implementation, however, is limited by challenges associated with estimating physical activity levels (PAL). We quantified the accuracy of the Sedentary Time and Activity Reporting Questionnaire (STAR-Q) derived PAL (PAL _STAR-Q ) combined with the Goldberg method (Goldberg-PAL _STARQ ) to identify EI misreporting as compared with doubly labeled water (DLW) derived total energy expenditure (TEE _DLW ). Between 2009 and 2011, 99 men and women completed a two-week DLW protocol, a food frequency questionnaire, and the STAR-Q. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the Goldberg-PAL _STAR-Q were determined. Fifty-eight percent of men and women were classified as under-reporters by Goldberg-PAL _STAR-Q compared with 60% of men and 56% of women by TEE _DLW . Among men, sensitivity, specificity, PPV, NPV and accuracy and 95% confidence intervals were 88% (68%-97%), 87% (61%-98%), 91% (72%-99%), 81% (56%-94%), and 87% (72%-95%), respectively; and among women 79% (62%-90%), 69% (50%-84%), 77% (60%-88%), 72% (52%-86%), and 75% (62%-84%), respectively. Validated individual level PALs used with the Goldberg method can be informative in sensitivity analyses to gain insight into EI misreporting in nutritional epidemiology studies lacking in objective EI measures.

Background: First Nations (FN) people in Canada are commonly diagnosed with colorectal cancers. Although Canada has treaty responsibilities to ensure FNs people have equitable access to quality health services, access to colorectal cancer screening in Canada by FNs people has not been fully assessed. Methods: The objectives of our retrospective population-level study that linked multiple administrative databases were to investigate differences in colorectal cancer screening rates: participation, retention, positivity, follow-up colonoscopy, and invasive colorectal cancer detection, as well as wait times to follow-up colonoscopy, and stages at diagnosis between FNs and non-FNs people in Alberta. All Alberta residents eligible for colorectal cancer screening (aged 50-74) between 2012 and 2018 were included. The study and descriptive methods adhered to FNs principles of ownership, control, access, and possession. Results: FNs people were less likely to participate in colorectal cancer screening (lower by 15.9% among women, P < 0.00001, and 17.0% among men; P = 0.0007), and less likely to be retained in the screening program (lower by 11.6%, P = 0.0013, among women and 9.9% %, P = 0.034, among men). They were more likely to screen positive (average difference of 7.0% among women and 7.3%, among men, both P < 0.0002). Invasive colorectal cancer detection rates were higher (3.2/1000) versus (2.3/1000) as were late-stage diagnoses (61% versus 43%, P = P = 0.004) among FNs people than non-FNs people, respectively. Conclusions: Higher invasive colorectal cancer detection rates and more late-stage diagnoses in FNs people can be due to lower participation and retention in colorectal cancer screening programs. Understanding and addressing the reasons for these inequities are needed to improve these outcomes for FNs people.

Women diagnosed with early-stage breast cancer can develop metastatic disease following successful initial treatment, with bone being the most common site of metastases. The Breast to Bone (B2B) cohort study of early-stage breast cancer patients was established as a research platform to study the basic biology of breast cancer to bone metastasis and to identify the factors that could improve prevention, early detection and treatment for this debilitating and incurable disease. The B2B cohort includes 478 women diagnosed with incident primary breast cancer (stages I to III) who were recruited from Calgary, Alberta and surrounding areas between February 2010 and July 2015. Four projects have been conducted to date, utilizing data and samples from this cohort. These studies have found the following: (a) women with insufficient or deficient levels of vitamin D (25[OH]D) concentrations in pretreatment serum samples had larger tumors and higher breast cancer grades, (b) several metabolomic biomarkers and cytokines were associated with tumor characteristics and time to recurrence, (c) additional biomarkers were found to be predictive for the high risk of bone metastasis and (d) circulating progastrin (hPG80) was associated with multiple survival outcomes. These research studies and future ones will provide new evidence on bone metastasis etiology in women diagnosed with early-stage breast cancer, improve identification of those at high risk and contribute to personalized treatment and prevention options.

Comprehensive evaluation of cancer screening activities based on individual experiences is urgently needed to address the burden of cancer among Métis people. In this co-designed and co-led study, a cancer screening questionnaire developed for Métis people to evaluate their cancer screening histories and to explore barriers and facilitators to cancer screening was used. Adult Métis Albertans were invited to participate in the anonymous survey through a multi-modal strategy used for community consultations. Descriptive analyses compared responses between regions, age groups and geographic locations. In total, 370 participants who identified as Métis consented and contributed responses between 12 September and 2 December 2022. Female respondents reported higher rates of cervical and breast cancer screening (>94%) and lower rates of colorectal cancer screening (67–78%). Most of the barriers and facilitators were rated as very important, especially access to reliable and accurate information on screening, risks and benefits of cancer screening, explanation of the test results or procedures, trust in their health care provider(s) and health care system and access to a primary health care provider. This study fills a crucial gap that can inform targeted interventions to increase cancer screening awareness and rates among Métis Albertans and reduce their cancer burden.